Breast cancer in BRCA mutation carriers: breast-conserving therapy or bilateral mastectomy?

JO Murphy, VS Sacchini

BRCA mutation carriers who are diagnosed with breast cancer can be overwhelmed with decisions. The choice between breast-conserving therapy, mastectomy or a bilateral mastectomy is often the first to be made by patients. Those who choose breastconserving therapy are faced with an increased risk of ipsilateral breast tumor recurrence and contralateral breast cancer; however, choosing more extensive surgery increases surgical morbidity without a proven survival advantage. Additional factors that influence surgical decision-making are the use of adjuvant therapy, the role of risk-reducing salpingooophorectomy and the biology of the breast cancer. Advances in surgical techniques, breast reconstruction and screening must also be considered when choosing the surgical treatment for breast cancer patients with a BRCA mutation.